Tinnitus

The Facts

Tinnitus (or "ringing in the ears") is sound or noise that no one but the person with the condition can hear. The noise can be constant or come in short bursts; it can last for long periods of time or go away fairly soon. The sound can be loud or soft, can change in pitch, and can be heard in one or both ears. Each person who has tinnitus can probably describe it in a different way.

It is estimated that about 10% to 15% of the population experience tinnitus. Some studies have shown that the prevalence of troublesome tinnitus increases with age, and it impacts both men and women equally.

Causes

The causes of tinnitus aren't completely known or understood and reasons can't always be found. In many cases, though, the sounds can be caused by illnesses or injuries such as:

heart disease or high blood pressure

infections in the ear or sinuses

drug side effects

blows to the head

hearing trauma such as exposure to loud explosions or to extremely loud music

hearing loss

objects lodged in the ear canal or a buildup of ear wax

dental problems

certain types of tumours

Symptoms and Complications

Tinnitus, by definition, is a subjective ringing or tingling in the ear that can only be heard by the person experiencing it. The noise can be described in many ways: a humming, buzzing, ringing, whistling, clicking, throbbing, or roaring. It's often a symptom of another underlying problem (see "Causes" above for a list).

Many people with tinnitus also have lost some or most of their hearing. In most cases, it's the hearing loss that ends up causing the problem.

The worst part of tinnitus is that it can be very annoying and difficult to live with. A soft ringing sound might not be too bothersome to most, but some people hear very loud sounds over long periods of time or sounds that go away only to return just as they get used to the silence again. This can affect sleep, concentration, and quality of life.

Making the Diagnosis

If you think you have tinnitus, your doctor may send you to an ear, nose, and throat specialist (ENT) to be assessed. You'll probably undergo a hearing test (auditory assessment) and might be sent for CT (computerized tomography) or MRI (magnetic resonance imaging) scans of the head to see if the source of the noise can be traced.

However, there are no objective tests for tinnitus. Rather, the diagnosis is based on your symptoms, history, and health questionnaires regarding the impact of tinnitus on your quality of life. Specifically, you'll be questioned on your medical history, medications you take, any history of head trauma, whether you're exposed to loud sounds, and even whether you smoke. Your doctor may ask if you're under more stress than usual, because sometimes depression or stress can bring on these episodes. It's also possible that a visit to the dentist may be recommended to see if a problem with your jaw is contributing to the situation.

Treatment and Prevention

Treatment of tinnitus depends very much on the cause. Because tinnitus is usually a symptom rather than an illness, treating the initial cause should help get rid of, or at least lessen, the sounds. Treatment could be one of the following:

antibiotics for infections

removing obstructions or wax from the ear canal

changing medications or dosages

treating certain neurological illnesses

surgery to correct joint problems

counselling for stress or depression

dental work

Currently, there are no medications in North America to treat spontaneous tinnitus of unknown cause. For the most part, tinnitus usually goes away by itself without treatment. It is permanent in about 25% of all cases.

When the cause of tinnitus can't be found, or if the cause is something that can't be fixed, there are some things that can be done to try to live with it. Whether or not this is necessary will depend on how loud and persistent the sound is, how annoying it is to the person, and if it's disturbing their daily life.

Some people with severe tinnitus use a technique called masking, in which a device is worn, much like a hearing aid, which provides a soothing or pleasing sound. This hides the annoying ringing or humming. The sounds can be different for each person. For example, some people may prefer to listen to the outdoors – bird calls, falling rain, or waterfalls. In some cases, masking can "train" the brain not to hear the annoying noises and, after a while, the device might not be needed all the time.

Other people don't need constant masking but use this technique when they're trying to fall asleep, concentrate, or rest. For this, they might use radios, tape recorders, CD players, or even household appliances like fans or air conditioners (this type of background masking is called "white noise").

Sometimes tinnitus is caused by hearing loss. A hearing test can determine if this is the case and whether a hearing aid might help. Often the aid will sharpen what's supposed to be heard and end up drowning out or hiding the unwanted sounds.

If you suffer from tinnitus, it's important to stay out of situations that can make it worse. This means avoiding noisy places and keeping music at a reasonable level. Also, being aware of medications that are toxic to living cells or to the ear (these are called “cytotoxic” or “ototoxic” medications) may help reduce the risk of developing tinnitus. Some doctors recommend staying away from caffeine and smoke, as these can irritate tinnitus.